From the Research
Tranexamic acid is recommended for managing uremic bleeding in patients with kidney failure, with careful consideration of the risk of thrombotic events, as evidenced by the most recent study 1. The typical dosing is 10-25 mg/kg intravenously every 6-8 hours, or 15-25 mg/kg orally three to four times daily, with dose adjustments required for patients with renal impairment, as suggested by previous studies 2, 3. Treatment duration is usually 3-5 days or until bleeding resolves. For patients on dialysis, administering the medication after dialysis sessions is advisable to prevent removal, as noted in the literature 4. Tranexamic acid works by inhibiting plasminogen activation and plasmin activity, thereby stabilizing blood clots and reducing bleeding, which is particularly beneficial in uremic patients who often have platelet dysfunction and altered coagulation, as described in 5. Some key points to consider when using tranexamic acid in this context include:
- Common side effects include nausea, vomiting, and diarrhea
- Serious risks include thrombotic events, so caution is needed in patients with a history of thrombosis
- Tranexamic acid should be used alongside other measures like correcting anemia, optimizing dialysis, and addressing underlying causes of bleeding
- In severe cases, desmopressin (DDAVP) may be added as adjunctive therapy at 0.3 mcg/kg intravenously, as suggested by previous studies 2, 3. It is essential to weigh the benefits of tranexamic acid against the potential risks, particularly in patients with a history of thrombosis, and to closely monitor patients for signs of thrombotic events, as noted in 5 and 1.